(102) Adolescent-Specific Risk and Protective Factors of Substance Use Among High School Students

Background & Introduction: Substance use remains a critical public health concern in the United States. According to the 2020 National Survey on Drug Use and Health (NSDUH), approximately 37 million Americans aged 12 and older reported using illicit drugs in the past month. Despite prevention efforts, nearly 47% of high school students use an illegal drug before graduation. Adolescent substance use is influenced by multiple factors, including individual, familial, and environmental determinants. While demographic and social determinants of health (SDOH) are well-documented risk factors, the roles of psychosocial behaviors, social involvement, and environmental conditions remain less understood, particularly among high school students. Moreover, substance use determinants may vary by substance type. Although adolescents who use multiple substances exhibit correlations, it is unclear whether shared risk factors contribute to these behaviors. Identifying both common and substance-specific risk factors is essential for developing targeted interventions. We hypothesize that adolescent-specific factors influence alcohol, tobacco, and illicit drug use among high school adolescents. Utilizing 2022 NSDUH data, this study aims to (1) assess the prevalence of substance use among high school students and (2) identify key risk and protective factors associated with alcohol, tobacco, and illicit drug use in this population.

Methods: This study utilized a cross-sectional design with data from the National Survey on Drug Use and Health (NSDUH), an annual, nationally representative survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Adolescents aged 12–17 who were currently attending or expected to attend high school (grades 9–12) as full-time students were included, yielding a final sample of 6,072 participants. The primary outcomes were imputed measures of alcohol, tobacco, and illicit drug use within the past year. Six adolescent-specific domains were examined: academic engagement and performance, antisocial behavior, youth enrichment activities, religious involvement, parental involvement, and substance use prevention education. Weighted percentages were calculated for each variable, and associations between risk and protective factors and substance use outcomes were assessed using Rao-Scott Chi-square tests. Multivariable logistic regression analyses were conducted to identify factors within these domains associated with past-year alcohol, tobacco, and illicit drug use, adjusting for sociodemographic variables (sex, race/ethnicity, English proficiency, insurance status, household poverty level, and family assistance). Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) and p-values were reported. All analyses, including weighted replicates, were performed using STATA 14.2 (College Station, TX).

Results: The study included 6,072 adolescents aged 12–17 enrolled as full-time high school students. Overall, 35.6% of U.S. high school students reported alcohol, tobacco, or illicit drug use. Alcohol was the most commonly used substance (23.5%), followed by tobacco (19.6%) and illicit drugs (18.0%). Substance use prevalence increased progressively from 9th to 12th grade. Additionally, alcohol use was significantly higher among non-Hispanic White students compared to Hispanic students (26.5% vs. 15.1%, p < 0.001). To examine associations between key variables (i.e., six adolescent-specific domain categories) and substance use outcomes, separate multivariable logistic regression analyses were conducted for alcohol, tobacco, and illicit drug use, adjusting for sex, race and ethnicity, health insurance, poverty status, family assistance, and grade level. Antisocial behavior was strongly associated with higher substance use (alcohol AOR = 2.54, 95% CI: 2.02–3.19, p < 0.001; tobacco AOR = 2.36, 95% CI: 1.92–2.89, p < 0.001; illicit drugs AOR = 2.66, 95% CI: 2.22–3.19, p < 0.001). Conversely, religious involvement was negatively associated with all substance use outcomes (alcohol AOR = 0.79, 95% CI: 0.64–0.97, p = 0.026; tobacco AOR = 0.71, 95% CI: 0.56–0.90, p = 0.006; illicit drugs AOR = 0.59, 95% CI: 0.45–0.77, p < 0.001).

Conclusion & Discussion:

Conclusion: One in three high-school students reported alcohol, tobacco or illicit drug use. Alcohol was the most used. Antisocial behavior by students was a risk factor for substance use across all categories, while religious involvement served as a protective factor against substance use. These findings highlight the need for early and effective interventions to reduce substance use among high-school adolescents.

Discussion: This study focused on high-school adolescents, a vulnerable population, providing a comprehensive analysis of their substance use, an area that is less frequently studied in literature. Additionally, the study identified substance use trends from freshman to senior years, revealing a pattern that suggests potential substance dependency development during adolescence, highlighting the need for early interventions. However, we only categorized substances into three broad groups which limits our ability to analyze individual product use. Future studies should include analyses that consider cultural and community-level factors associated with each substance’s use among high-school adolescents. Identifying risk and protective factors can aid teachers, parents, and policymakers in implementing effective interventions to reduce substance use among high school adolescents. Reducing substance use is essential to prevent substance-related negative outcomes, minimize mental health disorders, and avoid the development of addictive behaviors, especially during adolescence.

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